Breast cancer specialist reflects on 50 years of treatment progress
Professor Ian E Smith, a former head of the breast unit at The Royal Marsden Hospital and professor of cancer medicine at The Institute of Cancer Research, reflects on 50 years treating breast cancer patients, describing how outcomes have transformed since the 1970s. He recalls the era's often dehumanising practices, such as women being made to wait half-undressed for ward rounds, and contrasts this with today's far more effective and patient-centred care, noting that death rates have fallen from over 60 per cent in the 1970s to below 30 per cent now.
A pivotal moment in his career came in the 1980s when a patient, Mrs Baker, suffered severe side-effects from chemotherapy for secondary liver cancer, prompting him to recognise that hormone-blocking tablets could often achieve similar results with far less toxicity. This experience shaped his subsequent, more conservative approach to chemotherapy, an approach later validated by trials showing that for oestrogen-receptor-positive advanced breast cancer, hormone therapy is generally the better first-line treatment, with chemotherapy reserved until resistance develops. The article, part of a wider piece, also promises his views on the breast cancer risks linked to alcohol and HRT.
- Veteran oncologist reflects on 50 years of breast cancer treatment progress
- Death rates fell from over 60% in 1970s to under 30% today
- A patient's suffering taught him hormone therapy often beats chemotherapy first
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Breast cancer treatment has changed dramatically in Britain since the 1970s, when the disease killed more than six out of ten women diagnosed with it, care was often impersonal, and options were limited largely to surgery and harsh chemotherapy. Today the death rate has fallen to under three in ten, reflecting decades of medical research, new drug types and a shift towards treating patients with more dignity and choice.
One key development has been the growing use of hormone-blocking tablets for cancers that are fuelled by oestrogen, a common type of breast cancer. These drugs can control the disease with far milder side effects than chemotherapy, so doctors now often try them first and hold chemotherapy in reserve for later, once the cancer stops responding.
The reflections come from a senior oncologist who spent much of his career at a leading London cancer hospital and research institute, drawing on decades of direct experience with patients. His account matters because it charts how attitudes, evidence and treatment choices in breast cancer care have evolved, shaping the approach many patients encounter today.
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Originally published by Daily Mail as “Truth about the breast cancer risk from your nightly glass of wine – and HRT: I’m sharing everything I’ve learned in 50 years of treating patients… and this is where I think we’re going wrong: PROFESSOR IAN E SMITH”.